N.P.s and P.A.s

Meet the Providers on Your Health Care Team

What is a Nurse Practitioner?

Nurse Practitioner Nicholas “Niko” Lazarewicz sees patients at the Center for Primary Care in Vacaville.

A nurse practitioner, or N.P., is an advanced practice nurse with specialized training to diagnose and treat illness. A registered nurse acquires a nurse practitioner certification when he or she advances from a bachelor’s degree to a master’s or doctoral degree and qualifies through a national exam.

N.P.s diagnose, treat and help patients manage acute and chronic illnesses. They perform physical examinations, prescribe medications, interpret medical history and order and perform diagnostic tests and procedures. N.P.s at the NorthBay Center for Primary Care work collaboratively with physicians and provide medical appointments to several physicians’ patients.

“Working in a primary care setting is great,” said Nicholas “Niko” Lazarewicz, a nurse practitioner at the Center for Primary Care in Vacaville. “I get to see a broad range of patients, from children to seniors. And I get to form relationships that I hope will last for years.”

Niko graduated from college with a science degree and worked in medical research for a few years before deciding he wanted a job with more interaction with people. He found a four-year program at Samuel Merritt University in Oakland that would first turn him into a nurse and ultimately a nurse practitioner. As a nurse, he worked night shifts in an ICU while studying to qualify as a nurse practitioner. The N.P. course work included learning diagnostic skills, understanding pharmaceuticals, and having clinical rotations.
“Working as a nurse in the ICU was good training, but once a patient left the hospital, we never interacted again,” Niko said. His goal was to practice where he could get to know his patients and follow up on their health conditions.

At the Center for Primary Care he collaborates with several physicians, nurse practitioners and physician assistants to provide optimal care for patients. “We have a very supportive environment here. I feel very comfortable consulting with my colleagues when I have questions.”

In a busy practice, some days are a balancing act, but he makes sure he gives each patient the time they need. He said a good day is when he has a variety of patients, but a really great day is when he’s helped someone quit smoking.

“That doesn’t just make my day, it makes my week!

To help someone improve their health—well, that’s why I’m here!” Niko added.

High blood pressure makes you more likely to have heart disease or a stroke. Because it doesn’t usually cause warning symptoms, you could be at risk without even knowing it. It’s important to have your blood pressure checked regularly by a healthcare professional.
~Ehsan Ghods, D.O.


What is a Physician Assistant?

Physician Assistants, or P.A.s, are medical professionals with advanced education and clinical training. While they practice under the supervision of a physician, they exercise a great deal of autonomy in caring for patients.

“We do not ‘assist’ physicians as our title may imply,” said Joel Ambrosio, P.A., who collaborates with family practitioner Ehsan Ghods, D.O., at the NorthBay Center for Primary Care in Green Valley. “We are medical providers who hold our own licenses and are held to the same high standards as our physician colleagues.”

P.A. Joel Ambrosio, right, collaborates with Dr. Ehsan Ghods at the Center for Primary Care in Green Valley.

P.A.s take medical history, conduct physical examinations, diagnose and treat illnesses, order and interpret tests, counsel on preventive care and write prescriptions. Sometimes a “doctor’s appointment” is actually an appointment with a P.A.

“Joel has been a great complement to my team,” said Dr. Ghods. “He has been helpful in managing my patient panel by providing access to care for same day acute illnesses and follow-ups which allows me to be more available for complex cases that need more of my attention.”

The profession of physician assistant began in the mid-1960s when there was a shortage of primary care doctors. Dr. Eugene Stead of Duke University Medical Center had the idea of taking a group of military medics, who already possessed a high level of medical training and experience from the Vietnam War, and expanding their education to help fill the need for medical providers. He used the fast-track physician training curriculum used to supply doctors to the field during World War II as his model, and the P.A. profession was born.

“Through the years P.A. education has evolved to keep pace with the ever-changing environment of medicine, but we continue to train in the medical model similar to physicians,” Joel explained. He began his medical career as a medic in the Navy. He went on to graduate from the Stanford University School of Medicine Primary Care Associate Program, followed by earning a master’s degree in Physician Assistant Studies with a concentration in clinical medicine at A.T. Still University in Arizona. He studied pathophysiology, anatomy, genetics, microbiology, pharmacology and clinical skills, followed by a rigorous year of clinical training. During the clinical phase, he spent more than 2,000 hours divided into rotations in internal medicine, family medicine, emergency medicine, surgery, pediatrics, psychiatry and OB/GYN.

“Much of my clinical year was spent learning right alongside the medical students,” Joel added. “A P.A.’s training may be shorter compared to traditional medical school, but it is nonetheless very challenging.”

After graduation, P.A.s must sit for a national exam known as the Physician Assistant National Certifying Exam, or PANCE for short. Then they apply for licensing at the medical board of the state in which they wish to practice.

At the Center for Primary Care, physicians, physician assistants and nurse practitioners use a team approach to caring for their patients. On a typical day, Joel will see 10 to 12 patients, ranging from pre-op and post-Emergency Department appointments to primary care and minor procedures, such as suturing wounds.

“I enjoy getting to know patients and following them through their medical conditions,” Joel said. “Even the small victories, like getting someone back to work, or finding a solution to their problem, are very rewarding.”

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